Pump Up the Iron: As Many as 15% of Toddlers Don’t Get Enough

Babies and young children need iron to grow, but they’re not getting enough, according to the American Academy of Pediatrics (AAP). To compound the problem, tests for iron deficiency — babies get their fingers pricked near their first birthday and again between 15 to 18 months of age — just aren’t very reliable.With studies showing that up to 15% of toddlers ages 1 to 3 aren’t getting enough iron, the AAP called on Tuesday for more effective tests, along with doubling down on children’s iron intake. Iron is critical to cognitive development; studies have shown that babies who are anemic grow into children with stunted academic achievement and behavioral problems that extend into middle school. (More on Time.com: 5 Pregnancy Taboos Explained (or Debunked))

“Iron deficiency remains common in the United States,” says Frank Greer, former chair of the AAP Committee on Nutrition and co-author of the clinical report. “And now we know more about the long-term, irreversible effects it can have on children’s cognitive and behavioral development. It’s critical to children’s health that we improve their iron status starting in infancy.”

For the first four months of their lives, most babies can safely live off their iron stores. Formula is supplemented with iron, so bottle-fed babies are generally okay. But breast-fed infants need an iron supplement — 1 mg/kg of (yucky-tasting) orange-brown liquid a day. Parents can help by feeding their kids iron-rich foods.

“Ideally, we would prevent iron deficiency and iron-deficiency anemia with a diet consisting of foods that are naturally rich in iron,” says Robert Baker, a member of the executive committee of the AAP Section on Gastroenterology, Hepatology & Nutrition and co-author of the report. “Feeding older infants and toddlers foods like meat, shellfish, legumes and iron-rich fruits and vegetables, as well as iron-fortified cereals and fruits rich in vitamin C, which help iron absorption, can help prevent iron deficiency.” (More on Time.com: The ‘Other’ Salt: 5 Foods Rich in Potassium)

Although iron deficiency has been on the decline since iron-fortified formulas and iron-fortified baby foods first entered the market in the 1970s, studies have found that 4% of 6-month-olds and 12% of 1-year-olds don’t get enough iron. Most at risk: preemies, breast-fed babies and those at risk of developmental disabilities.